Introduction to Remote Video Auditing

Introduction to Remote Video Auditing of
Hand Hygiene Compliance in UK hospitals
GovToday offices, Manchester
12th March 2012

Maria Cann and Derek Butler met the team who are piloting a remote video auditing project in the UK. This is an exciting development in the arena of improving compliance with hand hygiene. The system has been tested in North Shore University Hospital in the USA and early discussions are taking place with colleagues in the NHS to look into using the technology here.

Left to right: Donna Armellino, Director of Infectious Diseases, North Shore University Hospital; Maria Cann, Secretary, MRSA Action UK; Derek Butler, Chair, MRSA Action UK; Adam Aronson, Chief Executive Officer, Arrowsight Inc; Dr Bruce Farber, Chief of Infectious Disease, North Shore University Hospital North Shore University Hospital Study Demonstrates Hand Hygiene Rates Improve Exponentially When Remote Video Auditing Technology Provides Continuous Feedback to Health Care Professionals

Nearly one out of every twenty hospitalized patients each year will develop a hospital-acquired infection (HAI). Of those infected, it is estimated that 100,000 will die. The cost to the healthcare system is approximately $45 billion and rising. Despite universally-accepted knowledge that hand hygiene among health care professionals is an intervention to reduce HAI, tools to encourage greater compliance among hospital staff have been largely ineffective. Hand hygiene rates in US hospitals have been documented as being very low in numerous academic studies, with some studies indicating hand hygiene rates as low 5%. Now, in a groundbreaking study just published in Clinical Infectious Diseases, North Shore University Hospital on Long Island is credited with taking a new approach to hand hygiene that has produced dramatic results. The hospital partnered with Arrowsight, Inc., developer of a patented 24/7/365 third-party remote video auditing platform (RVA) to monitor hand hygiene and conduct a pilot program to increase hand hygiene among health care professionals in their medical intensive care unit (MICU).

Over an initial 16-week period, the hospital staff were monitored to establish a base rate of hand hygiene compliance without any feedback to the staff. Using a very strict definition of hand hygiene (requiring health care workers to perform hand hygiene before and after patient care within 10 seconds of entering and exiting the room, regardless if gloves were used), their rates were right in line with previously documented findings at around 10%. The next 16-week period, staff received real-time feedback on their performance via LED screens mounted on the walls of the MICU and from management. Within weeks of providing feedback, the hand hygiene rate during the second period jumped to over 80%. During a subsequent 17 month maintenance period, a sustained rate of well above 80% was achieved. There were over 430,000 hand hygiene data points collected during the 25 month study period, making this the most comprehensive study ever conducted on hand hygiene performance.

The system is not focussed on individuals, and giving collective feedback has been shown to improve compliance to 95% and higher in some instances. Wards are competing with each other to be the best. Clostridium difficile has been seen to reduce. Everyone is accountable and where there is any slippage in compliance energies are placed on raising performance. Standards and expectations are clearly set out and everyone is aware of their responsibility.

This is a major breakthrough in providing a better standardised measurement of hand hygiene compliance and will save many lives in our opinion. It's our duty to not only aim to be the best, but to excel when we are caring for people when they are at their most vulnerable.

If you or someone you care about has been affected by a healthcare associated infection and you wish to discuss this with us, please contact us at

The information on this website is for general purposes only and is not a substitute for qualified medical care, if you are unwell please seek medical advice.

(c) MRSA Action UK 2012